Editorial -Paradigm Shift

Posted on
4/17/05

Paradigm Shift

By Joel L. Zive, R.Ph., PharmD.

Two months ago I wrote about my experiences in Rwanda helping a physician create an HIV pharmacy for her clinic in the Rwandan capital Kigali. One aspect of the trip I relished was the \"purity of the mission.\" Whereas when I awoke in the morning I would eat breakfast and pack enough food and water in my backpack to get my translator and I through the day. My only objective was accomplishing a health care goal. This was in stark contrast to my daily routine in the United States: dealing with wholesalers, keeping an eye on drug acquisition costs, and dealing with third party payors and the occasional ungrateful patient. Not to mention the myriad of responsibilities that comes with running a business.

Suffice to say a mild type of depression overcame me for two weeks after my return. It wasn?t that I did not miss my wife and family and did not appreciate my life in America. I just felt I left Rwanda too soon. Maybe another week or so just to make sure all the aspects of the pharmacy?s development I took responsibility were done.

It was when I gave a lecture at an HIV clinic during Black History Month that my perspective changed. Prior to my talk, a nutritionist was teaching patients how to calculate BMI (body mass index). This is not an easy concept to understand or calculate. I really do not know how many patients were able to fully grasp the calculations, but computing BMI was not the point.

The point was the nutritionist was empowering the patients to be aware of their weight. Coupled with this awareness was talking about the dangers of obesity and letting them try samples of protein shakes.

As we were drinking the shakes, I realized how fortunate HIV patients are in this country. I am standing in brand new HIV clinic, in a hospital that has been practicing HIV care for 20 years. There are practicing HIV specialists this clinic. When doctors and other health care providers write prescriptions, there are numerous pharmacies that will fill their prescriptions, deliver them, and usually never run out of stock on the medications. Being HIV-positive is no walk in the park, yet if you are HIV-positive, you definitely want to be living in the United States.

Then I realized the people in Rwanda would give their right arm to have the day-to-day problems we have in delivering health care. The reason why we have problems with third party payors is we have a health care infrastructure. While dealing with these issues is never enjoyable, I have become more tolerant and less frustrated in dealing with these daily problems.